In 2006, fire departments responded to 412,500 home fires in the United States. [1] Residential fires and burns are the third leading cause of unintentional home injury deaths and the ninth leading cause of home injuries resulting in an emergency department visit. [2] Mortality due to fires is highest among seniors and children under the age of 5. [2] The most effective interventions have been the use of smoke alarms, legislation / regulation controlling the flammability of fabrics, and making cigarette lighters child resistant. Community-based interventions to disseminate and install smoke alarms have also been shown to be effective. Regulation around the production and sale of fire safe cigarettes has been controversial at the federal level, but efforts continue to pass legislation to mandate this intervention which has been shown to be technically feasible to produce. [3-5]

Morbidity and mortality

Deaths

The United States has the fourth highest fire death rate of all industrialized countries. [6]

Of fire-related mortality, home fires account for nearly 90% of all fatalities. [2, 6]

An average of 3,402 persons die each year as a result of a residential fire or burn injury. [2]

Most victims of fires die from smoke or toxic gases (69%) followed by burns (about 15%). [1-3]

While cooking is the primary cause of home fires, most fire-related deaths are caused by smoking materials. [1, 2]

Children playing with fire account for 5% of all residential fires, but 40% of child fire-related death. [3]

Alcohol use contributes to an estimated 40% of residential fire deaths. [1]

Injuries and Emergency Room Visits

The home is where more than half of all nonfatal fire and burn injuries happen. [2]

An average of 261,326 nonfatal fire and burn injuries occur in the home every year. [2]

An estimated 92,500 emergency department visits were made by children under the age of 15 in 2002 for burn-related injuries. [7]

Where and when the deaths and injuries occur

One half of all deaths and 2/3 of child deaths or injuries in residential fires occur in homes where there is no working smoke alarm. [1,

Most residential fires occur during the winter months and most child deaths happen at night. [1, 3]

The South has the highest fire-related death rate in the country. [1, 3]

Populations at disproportionate risk

Children under age 5 and adults over age 70 are at increased risk of fire-related death.[1, 2, 5]

The rate of nonfatal fire and burn injuries among males under the age of 5 (308 per 100,000 persons) is more than twice that of any other age or sex. [2]

African Americans and Native Americans, and persons living in rural areas have greater risk of injuries from home fires. [1]

The poorest Americans and persons living in manufactured homes or substandard housing are also at increased risk for home fire injuries. [1]

Effectiveness of injury interventions

Smoke alarms

More than 95% of the households in a 2004 phone survey had at least 1 smoke alarm. Approximately half of home fire-related deaths occurred in the roughly 5% of homes without smoke alarms. However, in homes with smoke alarms in which home fires were reported, 65% of the homes had smoke alarms that did not work. Common reasons for non-working smoke alarms were missing, dead or disconnected batteries. [4]

Residential fire mortality rates in homes with working smoke alarms are 40-50% lower than those in homes not equipped with functioning alarms. [4, 8, 9]

Child resistant lighters

In 1994 the US Consumer Product Safety Commission issued a safety standard requiring cigarette lighters to be child resistant. Since that time the number of child-play lighter fires has gone down by 58%. It is estimated that the standard prevented 3300 fires, 100 deaths, 660 injuries, and $52.5 million in property losses in 1998. [3, 10]

Flame resistant fabrics

The Flammable Fabrics Act of 1972 regulated the flammability of sleepwear. One study showed 75% reduction in admission to burn units due to sleepwear related burns following passage of this act. [11]

Fire safe cigarettes

The technology to manufacture cigarettes that either have a low propensity to ignite substrates or that will self-extinguish when not puffed for a certain period of time has been available for well over a decade. In 1990, Congress convened the Technical Advisory Group for fire safe cigarettes which created a method to test ignition propensity of cigarettes, but due to tobacco industry protests, no further progress was made to federally regulate the fire safety of cigarettes. [5]

In 2000, New York passed legislation requiring fire safe cigarettes by July 2003. While not enough time has elapsed since the passage of the law to determine effectiveness, preliminary results appear promising. [5, 12]

Home sprinkler systems

Rates of death due to fires are higher in homes without sprinklers than in homes with sprinklers (9.4 deaths per 1,000 fires vs. 2.1 deaths per 1,000 fires). [13]

Sprinklers are effective in reducing death and injury because they react quickly to reduce heat, flames and smoke, allowing residents time to safely evacuate the home. In homes without sprinklers, fires are likely to grow to dangerous levels by the time the fire department is able to arrive. [14]

Homes with sprinklers are estimated to have 42% fewer property damage costs due to fires than homes without sprinklers. [13].

Multi-component interventions

Programs to distribute free smoke alarms to households in low-income, high-risk areas have proven to be effective at increasing smoke alarm use. One project in Oklahoma City was able to show that death rates and injuries from home fires were significantly reduced after their campaign in a high-risk area of the city, which included an educational campaign, publicity, and distribution of free smoke alarms. [15, 16]

A long-term, statewide prevention program, the Maine Burn Program, was able to demonstrate reduced hospital admissions and deaths due to burns and fires after implementation of a multi-component project which included establishing burn units in hospitals, promotion of safe installation and operation of wood stoves, legislation requiring smoke alarms and fire prevention education for school children. [17]

Installing both smoke alarms and a fire sprinkler system reduces the risk of death in a home fire by 82%, compared with homes that have neither. [14]

Cost and cost-effectiveness data

The average annual total medical costs of residential fires in the US is $7 billion. [2]

Every dollar spent on smoke alarms is estimated to save $69 in fire-related costs. [3]